Hard choices to be made in the political parlour
Column from Irish Independent on 8 July 2015.
Game on for Budget 2016, with the impending general election in sight. Last Friday, Tánaiste Joan Burton warned interest groups at the Social Protection forum in Dublin Castle that “the Budget isn’t a parlour game in which everybody puts out what they would like”.
Yet the same Minister for Social Protection has pledged a €5 increase for child benefit and there are noises about increasing social welfare rates for under-26s. Currently, unemployed 25-year-olds get €144 per week, while 18 to 24-year-olds are expected to live on €100 a week, well below the poverty line. While maybe not a vote loser, this was a particularly miserly measure by the current Government.
Meanwhile, it emerged that Taoiseach Enda Kenny was leading the charge against his own Government’s value-for-money review that recommended the closure and merger of small schools, 43 of which happened to be in his own constituency.
All sounds like good old parlour politics to me.
Last week, Health Minister Leo Varadkar made another pitch for more money for the health service. The headline catcher was an additional €700m to €1bn just to meet ‘unmet need’.
The fact that a health minister is even talking about unmet need is welcome. Ireland is unique in a European context in terms of high charges and long waits to access to essential care, which in turn contribute to unmet need.
This is evident wherever you turn. Well over half the population pay €50 for a GP visit, which puts people off seeking necessary treatment. These same people who are prescribed drugs have to pay up to €144 per month for essential medication. This deters essential use and results in poor health outcomes.
Those with medical cards who access GP visits for hospital care without charges can wait months or years for essential diagnosis or treatment which in turn leads to poorer health.
Other less high-profile, but perhaps even more important, areas are the extent of unmet need in the community – for people with disabilities, those enduring mental health conditions and chronic conditions. Often these are amongst the youngest and oldest and most at risk in society.
Meeting unmet need would mean all Irish people would get the appropriate treatment at the appropriate time. It deserves cross-party political attention and requires sustained additional funding over time. However, Mr Varadkar was also making another more subtle pitch, “unless you have the necessary resources in place, you won’t get rid of waiting lists and overcrowding”.
Despite getting a small but symbolic increase in the health budget last year and allocating an extra €75m to tackle the crisis in Emergency Departments earlier this year, progress is slow in reducing the numbers and length of time of those waiting.
Some improvement is evident for people stuck in hospital who don’t need to be there. Numbers of delayed discharges have reduced from 840 at the end of January to 637 in early June. The wait time for getting a nursing home bed has reduced from 11 to four weeks over the same period.
However, numbers waiting for emergency and planned hospital treatment remain hideously high. Latest trolley figures show that the June numbers waiting in Emergency Departments (ED) were at the highest level in three years and are higher than they were in 2011.
Although there has been some small progress on the actual ED waiting time, still nearly one in five of all ED attenders had to wait over nine hours to be either admitted or discharged. Planned hospital and day case treatment figures also remain persistently high, with more people waiting for outpatient appointments and planned hospital treatment than ever before.
At the end of June, over one quarter of a million people were waiting over three months for their initial specialist appointment and over 70,000 of these were waiting over a year. A further 7,147 were waiting over a year for hospital treatment once they had seen and were diagnosed by a specialist.
Mr Varadkar’s statement is recognition of the fact that the money and staff currently allocated to health are not sufficient to meet demand.
And none of the above takes into account the natural increase needed year-on-year just to meet increasing need driven by population growth and ageing, which requires an additional €240m just to stand still.
Mr Varadkar was there at the Cabinet table when successive Budgets cut more from health than it did from education or social protection. And he will be at it again this year when the three big spenders – social protection, health and education – will battle it out for their own portfolios.
Even if it is the last Budget before the election, it is just not feasible to give everyone in the Cabinet their desires, especially as they plan to do all this while cutting taxes.
But it is possible to prioritise those most in need, including those dependent on the public health system and those with unmet need.
Nevertheless, given Cabinet form to date, it’s unlikely that those in the political parlour would make such progressive choices – but the choices are theirs to make.